Gerard Gioia

Gerard Gioia
Children's National Hospital

PhD

About

149
Publications
102,860
Reads
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16,445
Citations
Citations since 2017
46 Research Items
9800 Citations
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Introduction
I am a pediatric neuropsychologist with multiple interests in areas including the executive functions, concussion/ mild traumatic brain injury, sports concussion, role of the executive functions in promoting exercise, sport participation, and healthy lifestyles across childhood and adulthood. I am a strong believer in a balanced and developmentally-appropriate approach to contact sports. We still have work to do to improve safety but we also do not need to throw out the "baby with the bathwater"
Additional affiliations
July 2002 - present
Children's National Medical Center
Position
  • Division Chief, Pediatric Neuropsychology
July 2002 - present
George Washington University
Position
  • Professor (Full)

Publications

Publications (149)
Article
Importance: Determining how the timing of return to school is related to later symptom burden is important for early postinjury management recommendations. Objective: To examine the typical time to return to school after a concussion and evaluate whether an earlier return to school is associated with symptom burden 14 days postinjury. Design, s...
Article
Objective To evaluate whether fenfluramine (FFA) is associated with improvement in everyday executive function (EF)—self-regulation—in preschool-aged children with Dravet syndrome (DS). Methods Children with DS received placebo or FFA in one of two phase III studies (first study: placebo, FFA 0.2 mg/kg/day, or FFA 0.7 mg/kg/day added to stiripento...
Article
Objective: The Behavior Rating Inventory of Executive Function (BRIEF) captures perceptions of an individual’s executive functioning in their everyday environment. Two self-report forms span late adolescence into early adulthood: BRIEF2 (ages 11-18) and BRIEF-Adult (ages 18-90). We compared responses on these forms in young adults to evaluate their...
Article
There is a paucity of research examining multivariate base rates (MBRs) of elevated scores in pediatric rating scales of cognition. We present novel MBR information on the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) for several clinical groups: Attention-Deficit/Hyperactivity Disorder Combined Presentation (ADHD-C); ADH...
Article
Metamemory is a component of metacognition that includes both the knowledge of factors that affect memory (i.e. declarative metamemory) and knowledge and application of factors in one's own learning and recall performance (i.e. procedural metamemory). The current paper aims to provide a comprehensive review of studies examining metamemory ability d...
Article
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Objective To assess the co-occurrence and clustering of post-concussive symptoms in children, and to identify distinct patient phenotypes based on symptom type and severity. Methods We performed a secondary analysis of the prospective, multicentre Predicting and Preventing Post-concussive Problems in Pediatrics (5P) cohort study, evaluating childr...
Article
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Background Children who experience a mild Traumatic Brain Injury (mTBI) may encounter cognitive and behavioral changes that often negatively impact school performance. Communication linkages between the various healthcare systems and school systems are rarely well-coordinated, placing children with an mTBI at risk for prolonged recovery, adverse im...
Poster
Full-text available
Objective: Multivariate base rates (MBRs) reflect probability information based on multiple variables (e.g., frequency of ≥4 low/high scores within a battery of 10 possible scores). There is sparse research examining MBRs in rating scales of cognition. We provide novel MBR information on the Behavior Rating Inventory of Executive Function, Second...
Article
The Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) is a standardized rating (self, parent, and teacher) scale of executive functioning in children and adolescents. Here, we provide multivariate base rate (MBR) information (for the Self, Parent, and Teacher forms), which is not included in the BRIEF2 Professional Manual. Pa...
Article
The Behavior Rating Inventory of Executive Function–Adult Version (BRIEF-A) is a standardized rating scale of subjective executive functioning. We provide univariate and multivariate base rates (BRs) for scale/index scores in the clinical range ( T scores ≥65), reliable change, and inter-rater information not included in the Professional Manual. Pa...
Chapter
The Pediatric Collections: Sports Medicine Playbook will increase pediatric providers’ understanding of the injuries that young athletes may incur – including their history, treatment, and prevention. Each section includes a unique expert introduction and they cover such topics as the benefits of physical activity, injuries, and concerns including...
Article
Objective: Retrospective self-report is typically used for diagnosing previous pediatric traumatic brain injury (TBI). A new semi-structured interview instrument (New Mexico Assessment of Pediatric TBI; NewMAP TBI) investigated test-retest reliability for TBI characteristics in both the TBI that qualified for study inclusion and for lifetime histo...
Article
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Objective Individuals with Dravet syndrome (DS) experience frequent pharmacoresistant seizures beginning in infancy. Most exhibit poor neurodevelopmental outcomes including motor function difficulties, behavior problems, and cognitive impairment. Cognitive deficits in children with DS have been associated with seizure frequency and antiseizure medi...
Article
Objective: To investigate whether preinjury physical, emotional, cognitive, and sleep symptoms on the Post-Concussion Symptoms Inventory (PCSI) are associated with persistent postconcussion symptoms (PPCS) at 4 weeks and whether any associations are moderated by sex or age. Study setting and participants: A total of 3063 participants with acute...
Article
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Importance The Four Corners Youth Consortium was created to fill the gap in our understanding of youth concussion. This study is the first analysis of posttraumatic headache (PTH) phenotype and prognosis in this cohort of concussed youth. Objective To describe the characteristics of youth with PTH and determine whether the PTH phenotype is associa...
Article
Objective The purpose of this study was to examine whether self-efficacy predicted pediatric concussion symptom severity and explore whether affective mood states (e.g., depression) influenced this relationship. Method Children (8–17 years) who were diagnosed with a concussion within 30 days of injury participated in the study ( n = 105). Followin...
Article
Traumatic brain injury (TBI) affects children’s ability to succeed at school. Few educators have the necessary training and knowledge needed to adequately monitor and treat students with a TBI, despite schools regularly serving as the long-term service provider. In this article, we describe a return to school model used in Oregon that implements be...
Article
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Importance Pediatric mild traumatic brain injury (TBI) and concussion are a public health challenge with up to 30% of patients experiencing prolonged recovery. Pediatric patients presenting to concussion clinics often have ongoing impairments and may be at increased risk for persistent symptoms. Understanding this population is critical for improve...
Article
Challenges with school learning following a concussion have become recognized more so over the past decade. Evidence-based assessment tools to identify these clinical problems and needs can facilitate critical supports for the recovering student. The Concussion Learning Assessment & School Survey, 3rd Edition (CLASS-3), developed to address this ne...
Article
Objective The Behavior Rating Inventory of Executive Function®—Adult Version (BRIEF-A) is a standardized measure that captures an adult’s executive functions in his or her everyday environment. The current study provides additional statistical evidence to support interpretation of BRIEF-A scores across raters and over time. Method Participants wer...
Article
Objectives: To evaluate parent-child agreement on postconcussion symptom severity within 48 hours of injury and examine the comparative predictive power of a clinical prediction rule when using parent or child symptom reporting. Methods: Both patients and parents quantified preinjury and current symptoms using the Postconcussion Symptom Inventor...
Article
In Reply Casper raises the question of why we excluded discussion of second impact syndrome in our consensus statement.¹ Second impact syndrome is an important topic with differing opinions regarding its pathophysiology and risk factors.² More research is needed to accurately estimate the risk of second impact syndrome and to learn best prevention...
Article
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Objective: Rapid developments in understanding the molecular mechanisms underlying cognitive deficits in neurodevelopmental disorders have increased expectations for targeted, mechanism-based treatments. However, translation from preclinical models to human clinical trials has proven challenging. Poor reproducibility of cognitive endpoints may pro...
Article
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Aim: Postconcussion symptom-rating scales are frequently used concussion assessment tools that do not align directly with new expert, consensus-based concussion subtype classification systems. This may result in delays in concussion diagnosis, subspecialty referral and rehabilitative strategies. Objective: To determine the representation of subt...
Article
Objective: In 2018, the Centers for Disease Control Prevention (CDC) published an evidence-based guideline on the diagnosis and management of mild traumatic brain injury (mTBI) among children. This commentary summarizes the key recommendations in the CDC Pediatric mTBI Guideline most relevant for neuropsychologists and discusses research gaps and t...
Article
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Background: Concussion is a heterogeneous mild traumatic brain injury (mTBI) characterized by a variety of symptoms, clinical presentations, and recovery trajectories. By thematically classifying the most common concussive clinical presentations into concussion subtypes (cognitive, ocular-motor, headache/migraine, vestibular, and anxiety/mood) and...
Article
Purpose Fatigue is a commonly reported complaint after concussion; however, fatigue is multi-faceted and a child’s experience of fatigue may differ from their parent’s observations. Differences in self and parent report of post-concussive changes in fatigue were examined. Methods Participants were 266 patients (Mean age=13.49, SD=2.75, range 5–18)...
Article
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Objective: To determine the stability of children's retrospective ratings of pre-injury levels of symptoms over time following concussion. Methods: Children and adolescents (n = 3,063) between the ages of 5-17 diagnosed with a concussion by their treating pediatric emergency department (PED) physician within 48 h of injury completed the Post-Concus...
Article
Importance The natural progression of symptom change and recovery remains poorly defined in children after concussion. Objectives To describe the natural progression of symptom change by age group (5-7, 8-12, and 13-18 years) and sex, as well as to develop centile curves to inform families about children after injury recovery. Design, Setting, an...
Article
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IMPORTANCE Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing public health concern because epidemiologic data indicate a marked increase in the number of emergency department visits for mTBI over the past decade. However, no evidence-based clinical guidelines have been developed to date for diagnosing and managing...
Article
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Importance Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing public health concern because epidemiologic data indicate a marked increase in the number of emergency department visits for mTBI over the past decade. However, no evidence-based clinical guidelines have been developed to date for diagnosing and managing...
Article
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Objective: To introduce and evaluate a measure of momentary symptom response to cognitive activity, a core feature of concussion. Setting: Concussion clinic at a large regional children's hospital. Participants: Individuals aged 5 to 18 years, comprising 3 clinical groups: uninjured (n = 590), recently concussed but clinically recovered (n = 1...
Article
Aim: Through a partnership with the National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), and Department of Defense (DoD), the development of Sport-Related Concussion (SRC) Common Data Elements (CDEs) was initiated. The aim of this collaboration was to increase the efficiency and effectiveness of cli...
Article
Objective To evaluate the evidence regarding (1) factors affecting return to school (RTS) and (2) strategies/accommodations for RTS following a sport-related concussion (SRC) in children and adolescents. Design A systematic review of original studies specifically addressing RTS following concussion in the paediatric and sporting context. Data sou...
Chapter
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Sport-related concussions are complex injuries of the brain. Since concussions can only be diagnosed clinically and manifest in different ways among athletes, diagnosis and management often require a multidisciplinary team approach. Sports neuropsychologists contribute to the team through their ability to assess cognitive, behavioral, and social-em...
Article
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Aim: To evaluate the evidence regarding the management of sport-related concussion (SRC) in children and adolescents. The eight subquestions included the effects of age on symptoms and outcome, normal and prolonged duration, the role of computerised neuropsychological tests (CNTs), the role of rest, and strategies for return to school and return t...
Article
This article presents the Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5). The Sport Concussion Assessment Tool was introduced in 2004, following the 2nd International Conference on Concussion in Sport in Prague, Czech Republic. Following the 4th International Consensus Conference, held in Zurich, Switzerland, in 2012, the SCAT 3rd...
Article
The acute care setting plays an important role in the proper diagnosis and management of mild Traumatic Brain Injury (mTBI) in children and adolescents. Increasingly, urgent care centers have become the frontline locations for most routine injuries in the evolving medical neighborhood. Urgent care centers have progressively become the sites for ini...
Article
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Objective: To assess the efficacy of lovastatin on visuospatial learning and attention for treating cognitive and behavioral deficits in children with neurofibromatosis type 1 (NF1). Methods: A multicenter, international, randomized, double-blind, placebo-controlled trial was conducted between July 2009 and May 2014 as part of the NF Clinical Tr...
Article
Objective: To determine whether shorter school-night sleep duration, greater daytime sleepiness, and greater eveningness chronotype were associated with lower self-regulation among adolescents. Methods: An online survey of 7th- to 12th-grade students in 19 schools in Fairfax County, Virginia Public Schools was conducted in 2015. Self-regulation...
Article
Objectives: The aim of this study was to demonstrate the utility of an evidence-based assessment (EBA) model to establish a multimodal set of tools for identifying students at risk for perceived post-injury academic problems. Methods: Participants included 142 students diagnosed with concussion (age: M=14.95; SD=1.80; 59% male), evaluated within...
Article
Importance: Persistent postconcussion symptoms (PPCS) pose long-term challenges and can negatively affect patients' health-related quality of life (HRQoL). To date, no large comprehensive study has addressed the association between PPCS and HRQoL. Objectives: To determine the association between HRQoL and PPCS at 4 weeks after concussion and ass...
Article
Purpose To examine the effects of subconcussive impacts resulting from a single season of youth (age range, 8-13 years) football on changes in specific white matter (WM) tracts as detected with diffusion-tensor imaging in the absence of clinically diagnosed concussions. Materials and Methods Head impact data were recorded by using the Head Impact T...
Article
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Background: Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment. Objective: To describe the cur...
Article
Background The District of Columbia’s “Concussion Protection Act of 2011” legislation requires training of youth sports program stakeholders to ensure concussion awareness and training to properly recognise, treat, and recover from a concussion. A partnership between the Children’s National Medical Centre, MedStar Sports Medicine and community stak...
Article
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The effect of repeated subconcussive head impacts in youth and high school sports on the developing brain is poorly understood. Emerging neuroimaging data correlated with biomechanical exposure metrics are beginning to demonstrate relationships across a variety of modalities. The long-term consequences of these changes are unknown. A review of the...
Article
Following sport-related concussion, the priorities for student athletes are return to school and extracurricular activities. Consensus-based practice recommendations emphasize rest and gradual resumption of activities. Specific evidence-based recommendations are not available. This article provides recommendations, strategies, and a general approac...
Article
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Following concussion, persistent changes in cognition in an elite athlete population is thought to occur. However, it is unclear if concussion history affects cognitive performance in a non-elite athlete population. PURPOSE: To assess the long-term effects of concussion history on cognitive performance in a non-elite athlete population. METHODS: Pa...
Article
The purpose of this study is to determine if the effects of cumulative head impacts during a season of high school football produce changes in diffusional kurtosis imaging (DKI) metrics in the absence of clinically diagnosed concussion. Subjects were recruited from a high school football team and were outfitted with the Head Impact Telemetry System...
Article
Importance Approximately one-third of children experiencing acute concussion experience ongoing somatic, cognitive, and psychological or behavioral symptoms, referred to as persistent postconcussion symptoms (PPCS). However, validated and pragmatic tools enabling clinicians to identify patients at risk for PPCS do not exist.Objective To derive an...
Article
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Objectives: To focus attention on building statewide capacity to support students with mild traumatic brain injury (mTBI)/concussion. Method: Consensus-building process with a multidisciplinary group of clinicians, researchers, policy makers, and state Department of Education personnel. Results: The white paper presents the group's consensus o...
Article
Effects of attention deficit hyperactivity disorder (ADHD) and stimulant medications on concussion measures are unclear. The objectives of this study were to (i) examine consistency of performance in an unmedicated ADHD group and a control group on concussion measures, (ii) assess performance differences between the two groups, and (iii) assess the...
Article
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The aim of this work is to study the nature and extent of the adverse academic effects faced by students recovering from concussion. A sample of 349 students ages 5 to 18 who sustained a concussion and their parents reported academic concerns and problems (eg, symptoms interfering, diminished academic skills) on a structured school questionnaire wi...
Article
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Sports-related concussions and repetitive subconcussive exposure are increasingly recognized as potential dangers to paediatric populations, but much remains unknown about the short-term and long-term consequences of these events, including potential cognitive impairment and risk of later-life dementia. This Expert Consensus Document is the result...
Conference Paper
Objective: Evidence-based assessment (EBA) offers an important perspective in the management of concussion, applying traditional strengths of neuropsychological assessment to individual clinical decision-making (Youngstrom, 2013). This study examined the predictive utility of the everyday executive functions to the identification of students at ris...
Conference Paper
Objective: The effects of cognitive overexertion (i.e., increasing symptoms in response to cognitive activities) are commonly reported during concussion recovery but have yet to be empirically explored in relation to school activities. This study examined the predictive utility of exertional effects to identify students at risk for post-injury acad...
Article
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Mild traumatic brain injury is recognized as a prevalent and significant risk concern for youth. Appropriate school return is particularly challenging. The medical and school systems must be prepared partners to support the school return of the student with mild traumatic brain injury. Medical providers must be trained in assessment and management...
Article
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Background: Significant attention has been focused on concussions in children, but a dearth of research evidence exists supporting clinical evaluation and management. Aim: The primary objective of this review paper is to describe a multimodal, developmentally adapted, standardized concussion assessment and active rehabilitation approach for chil...
Article
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Purpose: Because many sports concussions happen during school-sponsored sports events, most state concussion laws specifically hold schools accountable for coach training and effective concussion management practices. Brain 101: The Concussion Playbook is a Web-based intervention that includes training in sports concussion for each member of the s...
Article
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Objective: The aim is to investigate the everyday executive function (EF) in children with Tourette syndrome (TS), Inattentive or Combined presentations of ADHD (ADHD-I/ADHD-C), autism spectrum disorders (ASD), and typically developing children (TDC). Method: Nineteen TS, 33 ADHD-C, 43 ADHD-I, 34 ASD, and 50 TDC participated (8-17 years). Parent...
Chapter
The Tasks of Executive Control (TEC; Isquith, Roth, & Gioia, 2010) is a standardized computer-administered measure of two fundamental aspects of executive control processes or functions, namely, working memory and inhibitory control. It is designed for use with children and adolescents between the ages of 5 and 18 years, including those with a wide...
Chapter
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The Behavior Rating Inventory of Executive Function (BRIEF) was one of the first attempts to measure executive function via self- and informant reports of everyday functioning in the real-world environment and was the first published measure of these self-regulatory capabilities in children and adolescents (Gioia, Isquith, Guy & Kenworthy, 2000a)....
Article
The purpose of this study is to determine if the cumulative effects of head impacts from a season of high school football produce magnetic resonance imaging (MRI) measureable changes in the brain in the absence of clinically diagnosed concussion. Players from a local high school football team were instrumented with the Head Impact Telemetry System...
Article
Full-text available
Background: Previous research has demonstrated differences in cognitive performance when baseline concussion assessment is performed in a group versus an individual setting. Accurate baseline assessment is imperative when such data are used to make clinical decisions regarding cognitive and symptom recovery after concussion. Hypothesis: The use...
Article
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Psychometric characteristics of the Postconcussion Symptom Inventory (PCSI) were examined in both concussed (n = 633) and uninjured (n = 1,273) 5 to 18 year olds. Parent- and self-report forms were created with developmentally appropriate wording and content. Factor analyses identified physical, cognitive, emotional, and sleep factors; that did not...
Article
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Accurate recognition of pediatric concussion in the emergency department (ED) is important to ensure appropriate management for safe recovery. The study objective was to determine whether the Centers for Disease Control and Prevention's Acute Concussion Evaluation (ACE) tools, modified for ED use, improved patient follow-up and post-injury behavior...
Article
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Objective: To provide athletic trainers, physicians, and other health care professionals with best-practice guidelines for the management of sport-related concussions. Background: An estimated 3.8 million concussions occur each year in the United States as a result of sport and physical activity. Athletic trainers are commonly the first medical...
Article
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Abstract Executive dysfunction is present in children, adolescents, and adults with a wide range of clinical conditions. A growing body of literature has demonstrated the usefulness of rating scales designed to gauge executive functioning in everyday life. In this article, we discuss evidence supporting the use of such rating scales to assess inter...
Article
We aimed to evaluate parent-rated executive function (EF) in pediatric standard risk acute lymphoblastic leukemia (SR-ALL) survivors compared to a healthy comparison (HC) group. We hypothesized that SR-ALL survivors would have greater reported executive dysfunction compared to HC, and that those younger at the time of treatment would demonstrate gr...
Chapter
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